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UPPER GI ENDOSCOPY REQUEST FORM page 1 of 2 Please print details 1. Patient Details: Hospital no. NHS no. SurnameForenamesPrevious surnameTitleDate of Birth sex Female Male Address Post Wodehouse
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How to fill out upper gi endoscopy request

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How to fill out upper gi endoscopy request

01
To fill out an upper GI endoscopy request, follow these steps:
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Begin by entering the patient's personal information, such as their name, date of birth, and contact details.
03
Provide information about the referring physician, including their name, contact information, and any special instructions they may have.
04
Specify the reason for the upper GI endoscopy request, whether it is for diagnostic purposes or to monitor a pre-existing condition.
05
Include relevant medical history, such as previous endoscopic procedures, relevant surgeries, or known allergies.
06
Indicate the patient's current symptoms and any additional information that may assist the endoscopist in providing a comprehensive examination.
07
If necessary, mention any specific areas that require focus during the procedure, such as suspected ulcers, strictures, or abnormal growths.
08
Lastly, ensure that all necessary documentation is attached, such as any previous imaging scans, lab reports, or pathology results.
09
Remember to double-check the completed form for accuracy and completeness before submission.

Who needs upper gi endoscopy request?

01
Individuals who may require an upper GI endoscopy request include:
02
- Patients with persistent abdominal pain or discomfort
03
- Those experiencing difficulty swallowing or persistent heartburn
04
- Individuals with gastrointestinal bleeding, black stools, or unexplained weight loss
05
- Patients exhibiting symptoms of inflammation, such as chronic vomiting or diarrhea
06
- Individuals with a family history of gastrointestinal disorders or certain types of cancer
07
- Those who require monitoring of pre-existing conditions like Barrett's esophagus or peptic ulcers
08
Ultimately, the decision to request an upper GI endoscopy is made by a healthcare professional based on the patient's symptoms and medical history.

What is UPPER GI ENDOSCOPY REQUEST page 1 of 2 Form?

The UPPER GI ENDOSCOPY REQUEST page 1 of 2 is a Word document that should be submitted to the required address in order to provide specific information. It must be filled-out and signed, which can be done manually, or with a certain software e. g. PDFfiller. It lets you complete any PDF or Word document directly in your browser, customize it depending on your requirements and put a legally-binding electronic signature. Right away after completion, the user can send the UPPER GI ENDOSCOPY REQUEST page 1 of 2 to the relevant individual, or multiple recipients via email or fax. The blank is printable too thanks to PDFfiller feature and options offered for printing out adjustment. In both digital and physical appearance, your form will have got clean and professional appearance. You may also turn it into a template for further use, without creating a new blank form from scratch. All that needed is to amend the ready template.

Instructions for the UPPER GI ENDOSCOPY REQUEST page 1 of 2 form

Prior to begin filling out the UPPER GI ENDOSCOPY REQUEST page 1 of 2 word form, you'll have to make clear that all the required info is well prepared. This one is significant, as long as errors may lead to undesired consequences. It is really distressing and time-consuming to resubmit forcedly the whole editable template, letting alone the penalties caused by missed deadlines. To handle the digits requires more attention. At first glimpse, there is nothing tricky about it. Yet, it's easy to make an error. Professionals suggest to keep all required info and get it separately in a different file. Once you've got a template so far, it will be easy to export it from the document. In any case, it's up to you how far can you go to provide true and legit information. Check the information in your UPPER GI ENDOSCOPY REQUEST page 1 of 2 form twice when filling out all necessary fields. In case of any error, it can be promptly fixed within PDFfiller editing tool, so all deadlines are met.

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